What is atherosclerosis. How does it affect the body. What are the risk factors for developing hardened arteries. How is atherosclerosis diagnosed and treated. Can lifestyle changes prevent or manage this condition. What complications can arise from untreated atherosclerosis. How does age impact the development of hardened arteries.

Understanding Atherosclerosis: The Silent Threat to Cardiovascular Health

Atherosclerosis, commonly referred to as “hardening of the arteries,” is a prevalent cardiovascular condition that develops gradually over time. This disorder occurs when fat, cholesterol, and other substances accumulate in the arterial walls, forming deposits called plaques. As these plaques grow, they can narrow or completely obstruct arteries, leading to various health complications throughout the body.

The term “atherosclerosis” stems from the Greek words “athero” (meaning gruel or paste) and “sclerosis” (hardness). This aptly describes the process by which arteries lose their elasticity and become rigid due to plaque buildup. While atherosclerosis is often associated with aging, various factors can accelerate its progression, making it a concern for individuals of all ages.

The Progression of Atherosclerosis

How does atherosclerosis develop over time? The process typically follows these stages:

1. Initial damage to the arterial lining
2. Accumulation of cholesterol and other substances
3. Formation of fatty streaks
4. Growth of plaques
5. Narrowing or blockage of arteries

As arteries narrow and stiffen, blood flow becomes restricted, potentially leading to serious health issues such as heart attacks and strokes.

Risk Factors Contributing to Hardened Arteries

While age is a significant factor in the development of atherosclerosis, several other risk factors can accelerate the process. Identifying these risk factors is crucial for prevention and management of the condition.

Modifiable Risk Factors

• High blood cholesterol levels
• Unhealthy diet high in saturated and trans fats
• Smoking
• Lack of physical activity
• Obesity
• High blood pressure
• Diabetes

Non-Modifiable Risk Factors

• Family history of cardiovascular disease
• Age (risk increases with advancing years)
• Gender (men are generally at higher risk)

Can atherosclerosis be prevented? While some risk factors are beyond our control, adopting a heart-healthy lifestyle can significantly reduce the risk of developing hardened arteries. This includes maintaining a balanced diet, engaging in regular physical activity, avoiding tobacco use, and managing stress levels.

Recognizing the Symptoms of Atherosclerosis

One of the most challenging aspects of atherosclerosis is its silent nature in the early stages. Symptoms often do not manifest until blood flow to a part of the body becomes significantly impaired. When symptoms do appear, they can vary depending on which arteries are affected.

Common Symptoms Based on Affected Area

• Heart: Chest pain (angina), shortness of breath
• Brain: Sudden weakness, slurred speech, vision problems (signs of a stroke or TIA)
• Legs: Pain or cramping during physical activity (peripheral artery disease)
• Kidneys: High blood pressure, kidney failure
• Intestines: Abdominal pain after eating, unintended weight loss

Why is early detection of atherosclerosis crucial? Identifying and addressing the condition in its early stages can prevent severe complications and improve overall cardiovascular health. Regular check-ups and awareness of risk factors play a vital role in early detection and management.

Diagnostic Approaches for Atherosclerosis

Diagnosing atherosclerosis involves a combination of physical examinations, medical history review, and various diagnostic tests. Healthcare providers employ a range of tools to assess arterial health and identify potential blockages.

Physical Examination and Medical History

During a physical exam, a healthcare provider may listen to the heart and lungs with a stethoscope, checking for abnormal sounds such as a “bruit” – a whooshing or blowing sound that can indicate narrowed arteries. They will also review the patient’s medical history, lifestyle habits, and family history of cardiovascular disease.

Blood Tests

Blood tests are crucial for assessing cardiovascular risk factors. These may include:

• Lipid profile (cholesterol levels)
• Blood glucose levels
• High-sensitivity C-reactive protein (hs-CRP) test
• Homocysteine levels

Imaging Tests

Various imaging techniques can provide detailed views of the arteries and identify potential blockages:

• Doppler ultrasound
• Magnetic Resonance Arteriography (MRA)
• CT angiography
• Arteriograms or angiography

How often should adults undergo cardiovascular screening? Guidelines vary, but generally, adults should have their blood pressure checked annually and cholesterol levels tested every 4-6 years, starting from age 20. Those with risk factors may require more frequent screening.

Treatment Strategies for Atherosclerosis

Managing atherosclerosis typically involves a combination of lifestyle modifications and medical interventions. The primary goals of treatment are to slow or halt the progression of plaque buildup, reduce the risk of complications, and improve overall cardiovascular health.

Lifestyle Modifications

Adopting heart-healthy habits is fundamental in managing atherosclerosis:

• Quitting smoking
• Adopting a balanced, low-fat diet rich in fruits and vegetables
• Engaging in regular physical activity
• Maintaining a healthy weight
• Limiting alcohol consumption
• Managing stress

Medications

Depending on the severity of the condition and individual risk factors, healthcare providers may prescribe medications such as:

• Statins to lower cholesterol levels
• Antihypertensive drugs to control blood pressure
• Antiplatelet medications to prevent blood clots
• Diabetes medications to manage blood sugar levels

Surgical Interventions

In severe cases of atherosclerosis, surgical procedures may be necessary:

• Angioplasty and stent placement
• Endarterectomy
• Bypass surgery

What factors determine the appropriate treatment plan for atherosclerosis? Treatment decisions are based on various factors, including the severity of the condition, overall health status, age, and individual risk factors. A personalized approach is essential for optimal management of atherosclerosis.

Preventing Atherosclerosis: A Lifelong Commitment to Heart Health

While atherosclerosis is a common condition, particularly as we age, many of its risk factors are modifiable. Adopting a proactive approach to cardiovascular health can significantly reduce the risk of developing hardened arteries or slow the progression of existing atherosclerosis.

Key Prevention Strategies

• Maintain a heart-healthy diet
• Engage in regular physical activity
• Manage stress effectively
• Avoid tobacco use
• Control chronic conditions such as diabetes and hypertension
• Monitor cholesterol levels and blood pressure regularly
• Limit alcohol consumption

How effective are preventive measures in reducing the risk of atherosclerosis? Studies have shown that lifestyle modifications can significantly impact cardiovascular health. For instance, regular exercise can improve cholesterol levels, reduce blood pressure, and enhance overall heart function. Similarly, a diet rich in fruits, vegetables, whole grains, and lean proteins can help maintain healthy cholesterol levels and support arterial health.

The Role of Regular Check-ups

Regular medical check-ups play a crucial role in preventing and managing atherosclerosis. These visits allow healthcare providers to:

• Monitor vital signs and cardiovascular risk factors
• Detect early signs of atherosclerosis
• Adjust treatment plans as needed
• Provide personalized advice on lifestyle modifications
• Address any concerns or questions about cardiovascular health

By combining lifestyle modifications with regular medical supervision, individuals can take significant steps towards preventing atherosclerosis and maintaining optimal cardiovascular health throughout their lives.

Complications and Long-term Outlook of Untreated Atherosclerosis

Left unmanaged, atherosclerosis can lead to serious health complications affecting various parts of the body. Understanding these potential outcomes underscores the importance of early detection and proper management of the condition.

Potential Complications

• Coronary artery disease
• Heart attack
• Stroke
• Peripheral artery disease
• Aneurysms
• Chronic kidney disease

How does atherosclerosis contribute to these complications? As arteries narrow and lose elasticity, blood flow to vital organs and tissues becomes compromised. This reduced blood supply can lead to tissue damage or death, resulting in the aforementioned complications.

Long-term Prognosis

The long-term outlook for individuals with atherosclerosis varies depending on several factors:

• Severity of arterial narrowing
• Affected arteries and organs
• Presence of other health conditions
• Adherence to treatment plans
• Lifestyle choices

With proper management and lifestyle modifications, many individuals with atherosclerosis can lead healthy, active lives and significantly reduce their risk of severe complications. However, the condition requires ongoing attention and care to prevent progression and maintain cardiovascular health.

Emerging Research and Future Directions in Atherosclerosis Management

The field of cardiovascular medicine continues to evolve, with ongoing research aimed at improving our understanding of atherosclerosis and developing more effective prevention and treatment strategies.

Current Areas of Research

• Genetic factors influencing atherosclerosis development
• Novel biomarkers for early detection
• Advanced imaging techniques for better visualization of arterial health
• Targeted therapies to reduce plaque buildup
• Nanotechnology applications in diagnosis and treatment
• Role of inflammation in atherosclerosis progression

What promising advancements are on the horizon for atherosclerosis management? Researchers are exploring various innovative approaches, including:

• Gene therapy to address genetic risk factors
• Personalized medicine based on individual genetic profiles
• Development of new classes of lipid-lowering medications
• Improved stent technologies for better long-term outcomes
• Stem cell therapies to regenerate damaged arterial tissue

These ongoing research efforts hold the potential to revolutionize the prevention, diagnosis, and treatment of atherosclerosis, offering hope for improved cardiovascular health outcomes in the future.

The Importance of Continued Research and Education

As our understanding of atherosclerosis grows, so does the need for continued research and public education. Raising awareness about the condition, its risk factors, and prevention strategies is crucial for reducing its impact on global health.

Healthcare providers, researchers, and public health organizations play vital roles in:

• Disseminating up-to-date information on atherosclerosis
• Promoting heart-healthy lifestyles
• Advocating for policies that support cardiovascular health
• Encouraging participation in clinical trials and research studies
• Developing and implementing comprehensive cardiovascular health programs

By fostering a collaborative approach between researchers, healthcare providers, and the public, we can work towards a future where the burden of atherosclerosis is significantly reduced, and overall cardiovascular health is improved for populations worldwide.

Atherosclerosis: MedlinePlus Medical Encyclopedia

Atherosclerosis, sometimes called “hardening of the arteries,” occurs when fat, cholesterol, and other substances build up in the walls of arteries. These deposits are called plaques. Over time, these plaques can narrow or completely block the arteries and cause problems throughout the body.

Atherosclerosis is a common disorder.

Watch this video about:Atherosclerosis

Atherosclerosis often occurs with aging. As you grow older, plaque buildup narrows your arteries and makes them stiffer. These changes make it harder for blood to flow through them.

Clots may form in these narrowed arteries and block blood flow. Pieces of plaque can also break off and move to smaller blood vessels, blocking them.

These blockages starve tissues of blood and oxygen. This can result in damage or tissue death. It is a common cause of heart attack and stroke.

High blood cholesterol levels can cause hardening of the arteries at a younger age.

For many people, high cholesterol levels are due to a diet that is too high in saturated fats and trans fats.

Other factors that can contribute to hardening of the arteries include:

• Diabetes
• Family history of hardening of the arteries
• High blood pressure
• Lack of exercise
• Being overweight or obese
• Smoking

Atherosclerosis does not cause symptoms until blood flow to part of the body becomes slowed or blocked.

If the arteries supplying the heart become narrow, blood flow can slow down or stop. This can cause chest pain (stable angina), shortness of breath, and other symptoms.

Narrowed or blocked arteries may also cause problems in the intestines, kidneys, legs, and brain.

A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Atherosclerosis can create a whooshing or blowing sound (“bruit”) over an artery.

All adults over the age of 18 should have their blood pressure checked every year. More frequent measurement may be needed for those with a history of high blood pressure readings or those with risk factors for high blood pressure.

Cholesterol testing is recommended in all adults. The major national guidelines differ on the suggested age to start testing.

• Screening should begin between ages 20 to 35 for men and ages 20 to 45 for women.
• Repeat testing is not needed for five years for most adults with normal cholesterol levels.
• Repeat testing may be needed if lifestyle changes occur, such as large increase in weight or a change in diet.
• More frequent testing is needed for adults with a history of high cholesterol, diabetes, kidney problems, heart disease, stroke, and other conditions

A number of imaging tests may be used to see how well blood moves through your arteries.

• Doppler tests that use ultrasound or sound waves
• Magnetic resonance arteriography (MRA), a special type of MRI scan
• Special CT scans called CT angiography
• Arteriograms or angiography that use x-rays and contrast material (sometimes called “dye”) to see the path of blood flow inside the arteries

Lifestyle changes will reduce your risk for atherosclerosis. Things you can do include:

• Quit smoking: This is the single most important change you can make to reduce your risk for heart disease and stroke.
• Avoid fatty foods: Eat well-balanced meals that are low in fat and cholesterol. Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful. However, do not eat fried fish.
• Limit how much alcohol you drink: Recommended limits are one drink a day for women, two a day for men.
• Get regular physical activity: Exercise with moderate intensity (such as brisk walking) 5 days a week for 30 minutes a day if you are at a healthy weight. For weight loss, exercise for 60 to 90 minutes a day. Talk to your provider before starting a new exercise plan, especially if you have been diagnosed with heart disease or you have ever had a heart attack.

If your blood pressure is high, it is important for you to lower it and keep it under control.

The goal of treatment is to reduce your blood pressure so that you have a lower risk of health problems caused by high blood pressure. You and your provider should set a blood pressure goal for you.

• Do not stop or change high blood pressure medicines without talking to your provider.

Your provider may want you to take medicine for abnormal cholesterol levels or for high blood pressure if lifestyle changes do not work. This will depend on:

• Your age
• The medicines you take
• Your risk of side effects from possible medicines
• Whether you have heart disease or other blood flow problems
• Whether you smoke or are overweight
• Whether you have diabetes or other heart disease risk factors
• Whether you have any other medical problems, such as kidney disease

Your provider may suggest taking aspirin or another medicine to help prevent blood clots from forming in your arteries. These medicines are called antiplatelet drugs. DO NOT take aspirin without first talking to your provider.

Losing weight if you are overweight and reducing blood sugar if you have diabetes or pre-diabetes can help reduce the risk of developing atherosclerosis.

Atherosclerosis cannot be reversed once it has occurred. However, lifestyle changes and treating high cholesterol levels can prevent or slow the process from becoming worse. This can help reduce the chances of having a heart attack and stroke as a result of atherosclerosis.

In some cases, the plaque is part of a process that causes a weakening of the wall of an artery. This can lead to a bulge in an artery called an aneurysm. Aneurysms can break open (rupture). This causes bleeding that can be life threatening.

Hardening of the arteries; Arteriosclerosis; Plaque buildup – arteries; Hyperlipidemia – atherosclerosis; Cholesterol – atherosclerosis

• Abdominal aortic aneurysm repair – open – discharge
• Aortic aneurysm repair – endovascular – discharge
• Aspirin and heart disease
• Heart failure – discharge
• Heart failure – what to ask your doctor
• High blood pressure – what to ask your doctor
• Type 2 diabetes – what to ask your doctor

• Atherosclerosis
• Carotid stenosis – X-ray of the left artery
• Carotid stenosis – X-ray of the right artery
• Enlarged view of atherosclerosis
• Prevention of heart disease
• Developmental process of atherosclerosis

Arnett DK, Blumenthal RS, Albert MA, Buroker AB, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):1376-1414. PMID: 30894319 pubmed.ncbi.nlm.nih.gov/30894319/.

Genest J, Mora S, Libby P. Lipoprotein disorders and cardiovascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 27.

Libby P. The vascular biology of atherosclerosis. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022: chap 24.

Marks AR. Cardiac and circulatory function. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 47.

US Preventive Services Task Force website. Final recommendation statement: statin use for the primary prevention of cardiovascular disease in adults: preventive medication. Updated November 13, 2016. Accessed April 5, 2022. www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/statin-use-in-adults-preventive-medication1.

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):2199-2269. PMID: 2914653 pubmed.ncbi.nlm.nih.gov/29146533/.

Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A. D.A.M. Editorial team.

Arteriosclerosis & Atherosclerosis in Brighton, MA

What is Atherosclerosis?

Atherosclerosis is hardening of a blood vessel from a buildup of plaque. Plaque is made of fatty deposits, cholesterol and calcium. Plaque buildup causes the artery to narrow and harden. Plaque buildup can slow and even stop blood flow. This means the tissue supplied by the artery is cut off from its blood supply. This often leads to pain or decreased function. This condition can cause a number of serious health problems. Depending on the location of the blockage, it can cause:

• Coronary heart disease – loss of blood to areas of the heart
• Stroke – loss of blood to areas of the brain
• Peripheral vascular disease – loss of blood to the extremities

Atherosclerosis

Copyright © Nucleus Medical Media, Inc.

A hardened artery is more likely to be damaged. Repeated damage to the inner wall of an artery causes blood clots to form. The clots are called thrombi. They can lead to a further decrease in blood flow. A thrombus sometimes becomes so large that it completely closes off the artery. It could also break into clumps, called emboli. These clumps travel through the bloodstream and lodge in smaller arteries, blocking them off. The tissue supplied by the artery receives no oxygen. It quickly dies. When this occurs in the heart, it is called a heart attack . In the brain, it is called a stroke. Long-term atherosclerosis can also cause arteries to weaken. They may bulge under pressure. This bulge is called an aneurysm. If untreated, they can rupture and bleed.

Causes & Risk Factors for Atherosclerosis

Causes

Atherosclerosis is caused by plaque. Plaque is created by high levels of cholesterol and fat in the blood. Scar tissue and calcium from vessel injury can also add to the plaque buildup. The process leading to this may begin in childhood. It takes decades before it causes serious health problems.

Risk Factors

Men, especially those over 45 years of age, are more likely to have this condition. Atherosclerosis is more common in women over 55 years of age.

Factors that increase your chance of getting atherosclerosis include:

• Family history of the disease
• High cholesterol – especially low-density lipoprotein (LDL) cholesterol and low high-density lipoprotein (HDL) cholesterol
• High blood pressure
• Poor diet
• Cigarette smoking
• Diabetes type 1 and type 2
• Overweight and obesity
• Lack of physical activity
• Metabolic syndrome – a combination of three out of the following five findings:
  • Low HDL-cholesterol – also called good cholesterol
  • High triglycerides
  • Elevated blood sugar
  • Elevated blood pressure
  • Increased waist circumference – greater than 40 inches in men and 35 inches in women

Symptoms of Atherosclerosis

Early atherosclerosis does not have any symptoms. Symptoms may begin to appear as the arteries become harder and narrower. Symptoms can occur suddenly if a clot blocks a blood vessel or a large blockage breaks free. Symptoms depend on which arteries are affected. For example:

• Coronary arteries of the heart – may cause symptoms of heart disease, such as chest pain
• Arteries to the brain – may cause symptoms of a stroke such as weakness, vision problems, speech problems or headache
• Arteries in the lower extremities – may cause pain in the legs or feet and trouble walking

Diagnosing Atherosclerosis

Most people are diagnosed after they develop symptoms. However, people can be screened and treated for risk factors.You will be asked questions to help determine what arteries might be affected. You will also be asked about your symptoms and medical history. A physical exam will be done. Tests will depend on which arteries may be involved. Many of these tests detect problems with the tissue that is not getting enough blood. Tests that evaluate the atherosclerotic arteries are:

• Angiography
• Cardiac catheterization
• Ultrasound
• Electrocardiogram (ECG)

Treatments for Atherosclerosis

An important part of treatment is reducing risk factors. To do so, see the steps in the prevention section below. Treatment depends on the area of the body most affected. Treatment may include:

Medical Drug Therapy

Medications can:

• Interfere with the forming of blood clots
• Control blood pressure if elevated
• Lower cholesterol if elevated
• Improve the flow of blood through narrowed arteries

How to Prevent Atherosclerosis

Follow these methods to attempt to prevent and reverse atherosclerosis:

• Eat a healthy diet. It should be low in saturated fat and cholesterol. It should also be rich in whole grains, fruits and vegetables.
• Exercise regularly.
• Maintain a healthy weight. If you are overweight, lose weight.
• Don’t smoke. If you smoke, talk to your doctor about ways to quit.
• Control any chronic conditions you may have, such as diabetes.

If your doctor recommends it, take medication to reduce your risk factors. This may include medication for high blood pressure or high cholesterol. Talk to your doctor about screening tests for coronary artery disease if you have risk factors.

Words in science: The history of the origin of scientific terms. – M. : Tsentrpoligraf, 2006

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xw,*LKL. ,HHLOSprq*2643642S0

Diabetic skin diseases

1. What causes skin diseases in diabetes?

The most common cause of skin changes is severe hyperglycemia, antidiabetic drugs such as insulin or other ancillary drugs. In many cases, the exact causes are unknown. Observations show that people with significantly higher blood sugar levels have more frequent and more severe skin changes than people with a more favorable metabolic profile.

With long-term correct regulation of blood sugar levels and early detection, skin diseases can be localized, their development is reduced or completely prevented. Therefore, people with diabetes should examine and care for their skin daily. When skin changes appear, you should contact your diabetologist in a timely manner.

2. What increases the risk of developing skin diseases?

The main cause of skin changes is too high blood sugar levels. Elevated blood sugar triggers various processes in the body that alter the body’s immune response to infection-causing bacteria, viruses, and fungi and lead to complex disorders in the skin, connective tissue, and fat cells within and below the skin. High blood lipids and excess uric acid also increase the risk of skin changes.

3. What causes skin diseases in diabetes?

The skin conditions that can accompany diabetes are varied and their mechanism is often only broadly known. People with type 2 diabetes are more likely to develop skin infections, and people with type 1 diabetes are more likely to have autoimmune changes.

The so-called saccharification of proteins, fats and nucleic acids plays a major role in skin diseases in diabetes. The latter contain our hereditary information. The progressive saccharification of these molecules can change the structure and function of the skin and contribute to the development of blood vessel damage. Vascular disease and nerve dysfunction (peripheral and autonomic polyneuropathy), along with the weakened immune system associated with diabetes, also make sick people susceptible to infections and poor wound healing. The excessively high blood insulin levels (hyperinsulinemia) seen in type 2 diabetes due to insulin resistance also affects the proliferation and maturation of keratinocytes. This further impairs the barrier function of the skin and delays wound healing. Conversely, relative or absolute deficiency of insulin—usually accompanied by prolonged, too high blood sugar levels (indicated, for example, by high HbA1c levels)—can also adversely affect wound healing.

4. How can skin diseases be prevented in diabetes?

Correct regulation of blood sugar values ​​is the basis for the prevention of skin diseases. Proper management of lipids, uric acid and other risk factors for a long time prevents the appearance or further development of complications on the skin and subcutaneous tissues.

The following measures will help prevent skin diseases.

• Try to keep your blood sugar levels within the individually set range.
• Keep your leather clean and do not degrease it by washing too often with soap.
• Provide plenty of moisture to the skin, eg with lotion for normal skin and/or creams and ointments containing urea. Avoid hot baths and showers.
• Take care of your feet and check them daily for ulcers. Avoid using lotions, creams, or ointments between your toes unless you have fungal infections between your toes and on your nails. High humidity can encourage the development of fungus.

See your diabetologist if you notice any of the following symptoms.

• Noticeable skin changes
• Constant itching
• Severe keratinization of the feet
• Presence of ulcers (even small ones!) and poor healing of wounds
• Swelling or irritation at the place where the insulin was injected 900 04
• Skin lesions
• Changes on the hands and feet (eg, joint stiffness, trigger fingers, pain when moving the hands or feet, hardening of the palms)

5. Changes in the skin in the treatment of diabetes

All medicines, including those used to treat diabetes, may cause allergic reactions. Possible manifestations are redness of the skin, rash and itching. A rash on the skin of a larger area is also possible. However, in most cases, the drugs cause rather mild reactions, which the patient rarely reports.

Metformin

The diabetes drug metformin can, although rarely, cause serious allergic skin reactions, but it is also used to treat skin conditions. Studies show a particularly positive effect of metformin on acne and black acanthosis, in which the skin turns gray-brown.

Sulfonylurea

When taking a sulfonylurea after drinking alcohol or sun exposure, severe local reddening of the skin, dryness and itching may occur. Experts call this phototoxic reactions. The reason is the ingredients of sulfonylurea, which are not combined with alcohol and the sun. Most often, these changes disappear after 1 hour.

Insulin

The skin changes described above are also observed when using insulin . Now available – exclusively in Germany – highly purified human insulins and insulin analogues, as well as improved injection systems (applications) (pen and pump), these side effects of insulins have become rare. However, subcutaneous fatty tissue may change at the puncture sites. With frequent and repeated injections of insulin into a very limited area of ​​​​the skin, both a rather rare local decrease (lipoatrophy) and an increase in subcutaneous adipose tissue (lipohypertrophy) can occur. The processes that lead to these changes are not yet fully understood. To prevent it, it is best to change the injection site every time according to a certain system.

Insulin delivery catheter, the tip of which is placed in subcutaneous adipose tissue, can also cause significant skin irritation and even abscesses during insulin pump therapy. Therefore, people with insulin pumps should regularly change their catheter under sterile conditions.

Find out more about insulin therapy here!

Continuous Tissue Glucose Monitoring (CGM)

Skin changes are sometimes seen when monitoring blood glucose with Continuous Tissue Glucose Monitoring (CGM). In most cases, these are skin irritations that occur when the adhesive mechanism that fixes the monitoring system is worn for a long time (usually more than a week). As a result, the skin turns red, itches and becomes more vulnerable. Another cause of skin changes can be components of measuring systems, such as certain adhesives (acrylates), which cause itching and inflammation of the skin in some people.

6. Skin infections in diabetes

Skin infections are very common in people with diabetes and are directly related to long-term high blood sugar levels. Skin infections can be caused, for example, by bacteria and fungi.

Known bacterial infections include the following.

• Erysipelas . There are sharply defined red patches of skin that spread rapidly. They may be accompanied by swollen lymph nodes, fever, chills, and fatigue. The entry gates of infection are often small wounds. When severe, blistering may form and patches of skin may die (necrosis).
• Erythrasma . Most often in the folds of the skin or areas with profuse sweating (armpits, inguinal and anal-genital area, under the mammary glands), sharply defined scaly areas appear that become reddish-brown. Only rarely do people with erythrasma experience itching or other discomfort. If the area of ​​the lesion increases, it can lead to further infection of the skin.

Known fungal infections include the following.

• Candida infections . Skin changes caused by the yeast candida albicans often appear in the mouth, in skin folds, at the hair roots, or in the genital area in men and women. They can get wet, cause itching and burning. People with diabetes are also more likely to experience redness and painful swelling of the nail bed (candidal paronychia).
• Tinea (dermatophytosis, “carpet burn”) . These are skin, hair, and nail infections caused by filamentous fungi. In diabetes, the disease often occurs on the foot and between the toes. There are open areas with whitish edges. If the nails are affected, it is called nail fungus, in which the nail changes color and gradually breaks down (onychomycosis).

7. Skin diseases accompanying diabetes

Although diabetes itself is not the cause of the following skin diseases, some diseases are characteristic of diabetes.

Pseudo-acanthosis black

This refers to a group of different forms of the disease in which blurred grey-brownish velvety patches appear on the skin. The causes of occurrence are unknown. The neck area is usually affected first, later the armpits, the folds of the joints, or the groin. Few people with diabetes experience discomfort associated with these skin changes. In such patients, insulin resistance is often observed.

Scleroderma in diabetes

This term describes various changes in the connective tissue of the skin and underlying structures. It is caused, in particular, by saccharification of proteins (formation of so-called extended glycation products [AGE]) in the skin and underlying structures (connective tissue, tendons, joints). As a result, the location and formation of cross-links in collagen fibers changes. This results in reduced elasticity of the skin and joints (called limited joint mobility [LOA]). This can lead to significant, sometimes painful, multiple functional impairments, such as the hand, foot, and shoulder.

Hands :

• Thickening of the tendons of the palm (Dupuytren’s contracture)
• Stiffness of the fingers and joints (cheiroarthropathy, or stiff hand syndrome)
• Trigger finger (Tendovagin itis stenosans)
• Development of carpal tunnel syndrome, in which the median nerve pinched at the wrist. Because this nerve can no longer supply the hand, motor and sensory disturbances occur in the thumb, index, and middle fingers.

These changes are also seen in liver disease, in smokers with concomitant alcohol consumption, and in people with kidney failure with or without diabetes. Men suffer from this disease 5-10 times more often than women.

Feet : Impaired mobility of the ankle and toe joints with the risk of improper loading and injury in the sense of the so-called plantar fibromatosis (Ledderhose’s disease). This is accompanied by the appearance of knots and hardening on the sole of the foot.

Shoulders : Severe painful limitation of the shoulder joints (“frozen shoulder”)

Yellow nodules (xanthomas)

The lipid metabolism disorder that accompanies diabetes can lead to nodular fatty deposits on the skin. They are orange-yellow in color and are harmless in and of themselves.

Itching

Approximately one third of diabetics suffer from dry skin and itching. The reasons for this are dysfunction of the sweat and sebaceous glands. Scratching leads, as a rule, to increased itching. Scratching wounds can easily become infected with another pathogen.

Necrobiosis lipoidis

Skin lesions are often ring-shaped, reddish or brown. The skin can be affected over a large area, which can also lead to infection. Skin changes characteristic of necrobiosis lipoidica occur most often on the shins (in 85% of cases), sometimes also on the thigh, very rarely on the arms, upper body or face. Lipoid necrobiosis occurs 3 times more often in women than in men.

The course is slow, at the beginning intense red papules the size of lentils appear. Over time, they may develop into slightly indented, disc-shaped, yellow, hardened (sclerotic) lesions with visible blood vessels (telangiectasias) running through them. Over several months or years, the lesions may grow to the size of a palm and become brown-yellow, while the affected skin becomes thinner and thinner. In the worst case, open wounds and poorly healing ulcers can form. The cause of complex skin changes is unclear.

Pigmentation disorders

Painless sharply defined spots appear, most often on the shins, which may turn reddish or brown. The exact reason for this is unknown. Experts suggest that the cause of this is altered and damaged tiny blood vessels.

Vitiligo (dyspigmentation)

Usually between the ages of 10 and 30, depigmentation occurs and results in sharply defined white patches on the skin. Shape, size and quantity can vary greatly. These skin changes are often found in autoimmune diseases such as type 1 diabetes.

8. Changes in the skin due to secondary diseases caused by diabetes

Diabetic foot syndrome often causes damage to the skin on the feet. The causes of these serious and dangerous changes are disorders of nerve function (peripheral sensorimotor polyneuropathies, most often in combination with disorders of the autonomic nervous system) and circulatory disorders in the feet and legs (peripheral arterial obliterans disease [PAD]). Due to dysfunction of the nerves and ignorance of patients, pathological changes in the feet are very often not noticed, they are not given importance, or they are hushed up out of shame. People with skin lesions on their feet should seek immediate medical attention. This is always an emergency, as wounds can become very inflamed within a few hours and, in the worst case, there is a risk of amputation.

Find out more about diabetic foot syndrome here!

9.

How are skin diseases treated?

Diabetic skin diseases appear in various forms. The relationship between diabetes and skin disease is not known to many people with diabetes, and sometimes even diabetes experts. Therefore, regular examination of the skin – daily by the patient and regularly by the attending physician – is very important in order to start adequate therapy in time. Often helps in the long run

• normalization of metabolism (HbA1c values ​​ : 6.5-7.5 percent (47.5-58.5 mmol/mol)),
• sequential wound treatment and
• elimination of the causes of their occurrence, for example, drug replacement to prevent skin damage.

Dry skin is common with diabetes and can be alleviated with skin care products and avoiding hot baths or showers. Dryness is often accompanied by intense itching. Here oil baths, ointments or creams containing urea can help, and often the help of skin specialists (dermatologists).

For more serious conditions, such as fungal infection , antifungal medications prescribed by a doctor are used. It is important to clean the affected areas well and take care of them. Clothing that comes into contact with these areas should be changed daily and washed at 60 degrees Celsius if possible.

Infections caused by bacteria, such as wound erysipelas, are also very serious diseases and should be treated by a doctor. Given the severity of the disease, it is often necessary to prescribe antibiotics as early as possible.

For older people with diabetes who have severe joint mobility and who often have visual impairment (retinopathy, maculopathy, cataracts), the close social environment should be involved in the assessment of skin changes and their treatment.

For skin inflammation caused by certain adhesives (acrylates) in continuous tissue glucose monitoring (CGM) measuring systems, cortisone creams or ointments are used to treat skin changes in severe cases.